DECAF Score for Acute Exacerbation of COPD
Why Use
May assist clinical decision-making in terms of early discharge, escalation of care, or discussion of goals of care: Low risk (score 0-1) patients may be appropriate for early supported discharge. High risk (score 3-6) patients may be appropriate for higher levels of care and/or addressing goals of care. Higher scores may correlate with increased length of stay.
When to Use
Patients hospitalized with a primary diagnosis of acute exacerbation of COPD as follows: ≥35 years old. With or without pneumonia. Preadmission evidence of airflow obstruction on spirometry (FEV₁/FVC <0.70). ≥10 pack-year smoking history. Do not use if patient has <12 months life expectancy or is on home O₂.
Formula
Pearls / Pitfalls
The DECAF Score predicts in-hospital mortality in patients admitted to the hospital with acute exacerbation of COPD. Can be used in patients who have evidence of both pneumonia and COPD. Better predictor of in-hospital mortality than CURB-65 in patients who have both pneumonia and an acute exacerbation of COPD. Uses routinely available variables. Variables from initial labs are used to calculate the score. Requires Extended Medical Research Council Dyspnea (eMRCD) score, which may be difficult to obtain in patients with acute encephalopathy, dementia, or those who are intubated. Validated for use at the time of admission in UK hospitals, but not yet validated in US EDs.
Management
Was not studied to dictate management or treatment options. The score should not replace clinical judgment regarding workup, diagnosis, or treatment.
Critical Actions
Should only be used in admitted patients with a primary diagnosis of an acute COPD exacerbation, not in the outpatient setting or in patients whose COPD is stable. DECAF Scores 5–6 were found to have highest risk of death and shortest time to death, and may warrant early evaluation for escalation of care, higher level of monitoring, or potential palliative care.
Advice
Increasing DECAF Scores correlate with increased risk for in-hospital mortality. High risk DECAF Scores (3-6) are associated with both high risk of death and short time to death. Consider early escalation and higher level of monitoring versus palliative care for these patients. Low risk DECAF Scores (0-1) are associated with low mortality risk and these patients may be candidates for early discharge.
More Information
Interpretation: DECAF Score Risk Recommendation In-hospital mortality* 0 Low Routine management 0% 1 1.5% 2 Intermediate Use clinician judgment re: disposition 5.4% 3 High Consider escalation of care vs. palliative care 15.3% 4 31% 5 40.5% 6 50% *From Echevarria 2016 .